A Follow-up of the Thinking Healthy Programme
Duke University, USA; University of Liverpool, UK
Perinatal Depression, affecting a significant number of women in low-income countries, is a known risk factor for impaired child development. The purpose of this project is to explore whether a perinatal depression treatment (Thinking Healthy Programme, THP) leads to an improvement in the developmental outcomes in the offspring.In 2005, 903 pregnant women with perinatal depression from two rural sub-districts (Gujar Khan and Kallar Syedan) of District Rawalpindi, Pakistan were randomized into treatment and control arms. The women in the intervention arm received a Cognitive Behaviour Therapy (CBT) based psycho-social intervention (THP) through trained Lady Health Workers (LHWs), while the women in control arm received Enhanced Routine Care. The children of these mothers will now be 6-7 years old in 2012, thus allowing for an assessment of cognitive, socio-economical, motor and physical development outcomes.
The THP intervention provided a holistic approach on creating an environment for the mother to nurture her own and her surroundings through CBT techniques (active listening, collaboration with the family, guided discovery of alternative health beliefs, assigning of homework to apply what had been learned) into routine maternal and child health education through the LHW system in Pakistan. These THP sessions provided by the LHWs focused on identifying and modifying mood disturbances common in depression specific to how the mother perceives her own health, her relationship with the baby and the people around her (changing “unhealthy thinking” to “healthy thinking”). This intervention was accompanied with health education and supporting materials that were socio-culturally sensitive pictorial and verbal key messages to facilitate the discovery of alternative health beliefs. At 6 months post partum, 77% of mothers in the intervention group recovered from their depressive disorder compared to 47% in the control group, effects which were sustained at 12 months. Parents in the intervention group reported spending more time everyday on play-related activities.
The Proposed THP follow-up study consists of re-enrolling the original THP study participants and assessing developmental outcomes in the children. Furthermore, the LHWs who participated in the original study will also be interviewed to better understand the factors influencing the THP intervention in the field.
The specific domains we propose to assess include cognitive development, socio-emotional functioning, as well as overall health indicators. Our primary hypothesis is that children of mothers who participated in the THP will have better cognitive outcomes and socio-emotional functioning when compared to children of mothers randomized to the control group. Our secondary hypothesis is that there will be a convergence of developmental outcomes between the THP children and children of women who were not depressed prenatally. We will also collect data on potential mediators and moderators.
If the study demonstrates a positive impact of the intervention on child outcomes, it will provide a major impetus to policy-makers to address maternal depression in early child development strategies. The intervention, which is designed to be integrated into existing maternal and child health programs, and delivered by non-specialists, would provide a sustainable model for replication in other settings.